Background: Increased long-term risks of cardiovascular (CV) disease after CHEM for testicular cancer are well established whereas few studies have quantified the association of cisplatin-based chemotherapy with arterial thromboembolic events (ATE). We examined CVM in a large population-based cohort of TN survivors managed with modern combination CHEM, which usually includes cisplatin. Methods: Standardized mortality ratio (SMR) of CVM stratified by time since TN diagnosis were calculated for 15,006 TN survivors reported to the SEER program (1980-2010) initially managed with CHEM (n=6,909) or SURG (n=8,097) alone without RT, with each cohort accruing 60,065 (median 6.5) and 81,227 (median 7.9) person-years (PY) of follow up, respectively. Results: After CHEM, significant excesses of CVM occurred (n=54; SMR 1.4; 95% CI 1.03-1.8; absolute excess risk (AER) 2.4 per 10,000 PY) including deaths from heart disease (n=42; SMR 1.3; 95% CI 0.9-1.7), cerebrovascular disease (CVA) (n=10; SMR 2.4; 95% CI 1.2-4.4) and other arterial diseases (n=2; SMR 6.5; 95% CI 0.8-23.5). Excess CVM was concentrated within 1 yr after diagnosis, with SMRs during the <1, 1-4, 5-9, 10-14, 15-19 and 20+ yr periods 5.3 (95% CI 2.7-9.5), 1.7 (95% CI 0.9-2.9), 1.2 (95% CI 0.6-2.2), 0.9 (95% CI 0.4-1.9), 1.2 (95% CI 0.5-2.3), and 0.8 (95% CI 0.3-1.7), respectively. In particular, significantly elevated 4- to 22-fold risks of mortality due to either heart disease (n=6; SMR 3.5; 95% CI 1.3-7.5) or CVA (n=5; SMR 21.7; 95% CI 7.1-50.7) occurred in the <1 yr period. In contrast, among those managed with SURG only, no excess deaths were observed, either for all CVM taken together (n=50; SMR 0.8; 95% CI 0.6-1.1), heart disease (n=43; SMR 0.8; P>0.05) or CVA (n=7; SMR 1.07; P>0.05). Univariate Cox regression analysis showed excesses of CVM after CHEM vs. SURG (hazard ratio 1.5; 95% CI 1.01-2.2). Conclusions: Early ATE associated with modern CHEM may in part explain the excess deaths due to heart disease and CVA during the <1 yr period. Future analytic studies should not only quantify temporal trends of CV disease incidence and CVM in TN survivors, but include mechanistic investigations to facilitate the development of preventive efforts.